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Reducing Preventable Deaths: Where should the focus be?

By Richard A. McCartan  Posted by Rob Kall (about the submitter)     Permalink       (Page 1 of 2 pages)
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On September 11, 2001, the United States suffered its first foreign terrorist attack. The recent London subway bombings, which killed 56, are a sober reminder that the terrorist threat still exists.
Though no one can predict the likelihood of a second attack on the United States by Islamic terrorists, the federal government has undertaken an impressive array of expensive initiatives to guard against that potential.

The U.S. launched wars in Afghanistan and Iraq costing nearly 2,000 American lives and $300 billion and counting. President Bush 's prime justification is the need to fight terrorists overseas to prevent them from again attacking us at home.

The government combined 22 agencies and 180,000 employees into a single Department of Homeland Security, the most comprehensive federal reorganization in 50 years. DHS 's 2006 budget is $40.6 billion, much of which will be spent fighting terrorism. Additionally, over $18 billion has been awarded to state and local governments for this purpose.

Congress also passed the controversial Patriot Act, which restricts civil liberties, allows greater latitude to detain suspects, and provides law enforcement with unprecedented authority for searches and wiretaps.

There are multiple motivations for undertaking these extraordinary initiatives. Terrorist attacks can cause property and economic damage. But, of course, the prime motivation is prevention of further loss of innocent life as tragically occurred on 9/11. No one argues with the need to take reasonable anti-terrorism measures. However, the intensity of the government 's focus and the accompanying media coverage obscures a central reality: that in with many other problems, the government deliberately chooses not to adopt specific policies that would save significant numbers of lives.

For example, although each year about 45,000 are killed in traffic crashes and 3 million injured, the government fails to enact laws that could save many of those lives, according to The Advocates for Highway and Auto Safety. The group estimates that 11,900 deaths and 325,000 injuries could be avoided if everyone wore seatbelts. Yet, only 21 states allow police to ticket drivers who fail to wear seatbelts in the absence of another violation of the law.

Although each year about 500 children ages 4 to 7 die in crashes, only 28 states have booster seat laws. Car crashes are the number one killer of teenagers, claiming about 8,000 lives per year. Yet, 24 states have not adopted programs that place restrictions on the licenses of teenage drivers.

Even though each year about 10,000 die in rollover accidents, the federal government has not adopted adequate performance rollover safety standards. Another danger, speeding, is involved in about one-third of the fatal crashes. Lowering the speed limit to 55 reduces accidents, and yet about 29 states post speed limits of 70 or higher. Moreover, only four states employ speed photo radar widely used in many other countries to catch speeders.

In 2002, large trucks (over 10,000 pounds) were involved in 4,897 deaths. For mileage traveled, large trucks are 50 percent more likely than other vehicles to be involved in a fatal accident. Yet, trucks keep getting bigger, and calls for increased safety regulations go unanswered. Even stricter DWI laws could reduce the 15,000 fatal accidents each year that involve alcohol use.

The National Highway Safety Administration estimates that as many as 10,000 deaths per year are caused by driver distraction (i.e., cell phones, music, children, or food/drink). Experts agree that many of these deaths are preventable through better driver education and requiring two hands on the wheel. In particular, the danger of cell phone in cars has garnered much recent attention. A Virginia Tech University study videotaped 100 cars and their drivers for one year, and detected 638 evasive actions and six actual accidents resulting from cell phone use. The Wall Street Journal reports that cell-phone users are four times more likely to be involved in a serious accident. Yet, only three states have banned hand-held phone use by drivers.

Even far greater reductions in preventable deaths could occur through improvements in health care.

A comprehensive 2004 study by the National Committee for Quality Assurance (NCQA) found that if all Americans received care from one of the top10 percent of health plans, between 42,000 and 79,000 lives would be saved each year. According to the study, the most significant areas for improvement included cholesterol management, controlling high blood pressure, diabetes care, flu shots for adults over 65, and smoking cessation. The study concluded that the government could improve the quality of care by financially rewarding plans that perform well.

NCQA also estimates that about 100,000 patients die every year from either medical error or neglect, a number that could be reduced by more than 50 percent through investment in new computer technologies that would provide more accurate information on a patient 's state of health

Additionally, about 44 million Americans (80 percent of who work) cannot afford health insurance. Taxpayers and private entities currently pay about $125 billion in charity care for the uninsured, according to a recent report by the Henry J. Kaiser Family Foundation. Kaiser estimates that for an additional $48 billion, these uninsured Americans could be covered.

The uninsured pay out-of-pocket for some care, and also receive some charity care. But the fact is that nearly half of uninsured adults have chronic conditions, and often go without needed medical care, leading to much higher mortality rates than for insured adults, according to a recent study by the Robert Wood Johnson Foundation. The Foundation estimates that about 18,000 adults die every year because of no health insurance, and of course many more suffer preventable illness.

USA Today recently reported that drug companies for financial reasons are unwilling to develop drugs specifically designed for the 12,400 children who contract cancer each year. Experts are calling for a "public-private partnership " to jump-start new development of these drugs that could save many lives and reduce the damaging side effects associated with current treatment options for these children.

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